Robot brings quick help to stroke patients

New technology links stroke victims with distant experts

By Joyce Davis For the Reporter-Herald

Posted:
02/23/2013 11:00:23 AM MST

Celeste Rhys, registered nurse manager at the McKee Medical Center's emergency department, poses Wednesday next to a stroke robot at the hospital. The robot scans a patient's body head to toe and sends the information to Swedish Medical Center, where a neurological team is immediately available and can determine the type of stroke and treatment.
(
Jenny Sparks
)

It may sound like something out of a science fiction movie, but if you're having a stroke, a robot may be your best friend.

Because time is one of the most critical factors in the successful treatment of a stroke, a patient needs a team of experts on hand to provide immediate care. When that's not possible, the stroke robot comes into play.

A form of telemedicine, the telestroke program allows neurologists to remotely evaluate stroke patients, make a diagnosis and recommend treatment to emergency physicians at other sites. The program is set up as a hub-and-spoke system with a comprehensive stroke center at the hub and hospitals in other locations as the spoke. The spoke sites may be in smaller cities or even in rural areas.

Using digital video cameras, an on-site robot, the Internet, smart phones and other technology, the expert physicians are able to make a prompt evaluation for life-saving treatment.

McKee Medical Center in Loveland and North Colorado Medical Center in Greeley use the stroke robot program in partnership with Swedish Medical Center in Denver.

Celeste Rhys, registered nurse manager at McKee Medical Center's emergency department, says the robot provides a sense of comfort to the patient and staff. "They know they're getting the expert care they need by bringing the stroke center to them," she says. "The specialist can get a full look at the patient, even coming in for a close look at the face, the legs or arms for evaluation."

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According to the American Stroke Association, one of the most effective medications for certain types of stroke must be administered within 4.5 hours after stroke symptoms begin. The robot technology allows for patients to receive these critical clot-dissolving therapies (called thrombolytics) or other treatments to thwart severe disability and possible death within that window of time.

Using state-of-the art secured video links, the robot telestroke system features a hotline to vascular neurologists who are on call 24/7. Response time is usually within five minutes and involves other hub personnel such as radiology technicians, nurses and research experts.

Prior to calling the neurologist, the ER staff has usually completed a CT scan, along with the patient's medical history and other tests.

The patient is examined by means of a high-definition camera placed on a robot at the patient's bedside. The robot's screen and microphone provide two-way video and audio communication between physicians in the emergency room and the hub team. Through the robot, the neurologist can interview and assess the patient, speak with family members and consult with care providers as if he or she was in the room.

"It's like having a specialist at our fingertips," Rhys says. "It's easy to set up and usually by the time we're ready to use it, the specialist is already dialed in. It's really a piece of cake -- I call it a neat toy, one of my favorites."

Stroke is the country's third-leading cause of death, taking the lives of about 130,000 people in the United States and causing severe long-term disability for others, according to the Centers for Disease Control and Prevention. There are three types, each indicating a different type of treatment. An ischemic stroke occurs when blood flow to the brain is blocked by a clot in an artery, blocking the flow of blood, and the oxygen it carries, to the brain. A hemorrhagic stroke results when there is bleeding from the small brain arteries into the brain.

A TIA, a transient ischemic attack, is a temporary blockage that lasts a few minutes but does not cause brain damage. A TIA can be a precursor to an actual stroke.

The stroke robot program allows patients to receive immediate critical care as if they were in a major hospital. And thanks to the technology, this emergency treatment may alleviate the need for a patient to be transported to a different hospital.

It's the use of state-of-the art technology that might appear cold and impersonal at first look, yet is anything but. "The pictures and voices are so clear, you feel they're actually in the room. It's like having a warm body right there with us all the way," Rhys says.

1997-2007 -- the years during which the stroke death rate fell by 34 percent and deaths fell by 18 percent.

7 million -- the number of stroke survivors in the U.S.

FAST rule to identify someone having a stroke

Face Drooping -- does one side of the face droop or is it numb? Ask the person to smile.

Weakness-- is one arm weak or numb? Ask the person to raise both arms; does one arm drift downward?

Difficulty -- speech slurred, the person unable to speak or hard to understand? When asked to repeat a simple sentence such as "the sky is blue," is the sentence repeated correctly?

To call 911--of the above symptoms --even if they go away -- are cause to call 911 and get the person to the hospital immediately. Success of treatment depends on promptness. One of the most effective medications for ischemic stroke -- when a clot or plaque blocks blood flow to part of the brain -- must be administered within 4.5 hours after the stroke begins.

Other stroke symptoms

Sudden numbness or weakness of the leg, sudden trouble walking, dizziness, loss of balance of coordination.

Sudden confusion or trouble understanding.

Sudden trouble seeing in one or both eyes, sudden severe headache with no known cause.

Stroke risks

Some risk factors can't be changed. Family history plays a role and so does age, with the stroke risk doubling in every decade after age 55. Men are at higher risk than women; American blacks are at risk more than other ethnic groups. Unmanaged diabetes, heart disease and obstructive sleep apnea increase the risk of stroke. Controllable risk factors include hypertension, unhealthy cholesterol levels, heavy alcohol use and inactivity.

A stroke survivor is at increased risk for a second stroke. Within five years, 24 percent of women and 42 percent of men will have another one.

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